Chapter 6: History of Embalming and Restorative Arts 3 CE Hours

By. Elite Staff

Learning objectives

ŠŠ Discuss some of the reasons different cultures have embalmed ŠŠ Name three inventions that significantly changed embalming their dead. techniques in the 1800s and 1900s. ŠŠ Describe the process and materials used to embalm the dead in ŠŠ Name the first well-known “demisurgeon” whose restorative ancient Egypt. techniques were a sensation in the early 1900s. ŠŠ Discuss the historical changes affecting the embalming policy ŠŠ Discuss the findings from the recent National Cancer Society from the Dark Ages through the Renaissance. research, published in November 2009, and how this may affect ŠŠ Explain how the Civil War changed the history of embalming. the use of formaldehyde in embalming. ŠŠ List three noted early American embalmers and their contributions ŠŠ Explain the risks of arsenic in old cemeteries and embalmed to the field. bodies and how to protect yourself from exposure to arsenic.

Introduction

This chapter is presented in two parts. The first part of the chapter discusses possible risks of embalming, including those associated with discusses the history of embalming, introducing significant practitioners formaldehyde exposure highlighted in recent research findings, and the and authors, the invention of innovative devices and techniques, and the hidden danger of arsenic in historic cemeteries. subdiscipline of restorative techniques. The second part of the chapter

PART I: Embalming – a long history Men and women have practiced human preservative methods and became critical for transportation or viewing associated with funeral restoration art since early times, to restore and maintain bodies and memorial celebrations, to display the body as is the tradition in free from decomposition and return the body to its natural lifelike many cultures and faiths, and provide a sense of peace and closure to appearance. The reasons for the practice are varied and distinct to family members and friends. each culture. The ancient Egyptians practiced their embalming and This section highlights some of the significant individuals, inventions mummification techniques to meet religious goals involving the and techniques in the history of embalming, from ancient through afterlife. In more recent times, the practice was a matter of necessity; modern times, describing the incredible range of materials and the early study of anatomy and the technique of dissection, for methods used to make tools and embalming fluids. It also reviews example, necessitated some method or material that would allow a history of modern restorative art, which emerged as an important the corpse to be studied for longer periods in warm as well as cold subdiscipline in the early 1900s. weather. Not least significant, embalming and restorative methods

Embalming defined

Embalming refers to the preservation of the dead human body by Humans around the world and throughout history have developed specific actions conducted by human beings. It is “man-made,” in that scores of fascinating methods and materials for preserving dead it requires specific types of intervention and treatment of the body that bodies. Ancient Sicilians had a method that used heat; ancient necessitates human action. In some parts of the world, elements of the Egyptians used evisceration and immersion in their special solution; climate, such as extreme cold or dry heat, act as a natural preservative, arsenic and mercury were popular for a while, and, more currently in creating corpses that do not decompose and maintain their form for this country, arterial injection and cavity treatment became the norm. great lengths of time. These natural processes do not require human intervention and are not considered embalming.

Historical periods

Embalming history is composed of a number of distinct periods. Our ritual, and Arab conquerors also rejected the practice of embalming. Still, earliest knowledge of embalming is that which occurred in Egypt over Egyptian methods recorded by historians of the day would emerge many 5,000 years ago. It continued, with variation in practices and materials years later, influencing embalming in other parts of the world. over time and location, for almost 4,000 years, ending in about 650 ACE. The second main epoch of embalming history is the period of the Egyptian embalming was a religious practice, as preservation of the body Renaissance in Europe, a period in which embalming techniques were was a necessary precursor to resurrection in the afterlife. As Christianity primarily used to preserve the dead for purposes of dissection and study. became more dominant in the area, the practice was suppressed as a pagan

Page 81 Funeral.EliteCME.com The third distinct period is modern history, from 1861, the start of officials, whose bodies might travel to a number of locations for the Civil War, to the present day. During the Civil War, embalming memorial services. Additionally, embalming allowed viewing of the became more common (at least among Northern officers), initially body without showing all the ravages of war. In this third, and current required by public transportation services before they would take a period, embalming is available to nearly everyone who requests it, corpse to its final resting place from the battlefield location. It became where once it was only available to nobility or the wealthy. an invaluable means for maintaining corpses of prominent military

Ancient Egypt

Well over 5,000 years ago, Egyptians did not embalm their dead. In order to keep the body from decay in the warm Egyptian climate, Instead, they prepared the dead by folding the arms and legs of the they had to construct a method to preserve body tissues over time. body and placing the body in the fetal position, wrapped in a simple While we do not know exactly how it began, it is likely that methods cloth or fiber mat, and buried on its side in a shallow grave in the common at the time for preserving meat, fowl or fish probably desert. The location was specific: west of the Nile River, in some cases suggested a clue for early techniques. One might bleed a fish, for with pottery or other items. Because the body was surrounded by hot, example, then preserve it by salting, smoking, sun drying or otherwise porous sand in an area with virtually no precipitation, the climate acted heating it to prevent decomposition and store it for a later time. By the as a preservative, extracting all moisture from the body. time of the very earliest documentation of the process of embalming By about 5,000 years ago, Egypt had become a bustling hub with (in about 500 BCE), it had become a sophisticated technique that had a growing population and increasing wealth. Those with titles and been evolved over hundreds of years. Embalming methods varied wealth wanted more than a simple burial. Because one’s body and by era as well as by individual embalmers. Additionally, a number certain organs in it (but not all), as well as specific possessions, would of different services were usually available to the customer, ranging be required in the afterlife, it was problematic to just leave a body in in price according to materials and time involved. In most historical the sand to dry, as it could easily be uncovered by winds and exposed accounts, there are three options provided family members of the or be robbed of the items buried with it. To ensure that they entered deceased, distinctly defined as low to high quality. the afterlife with their body and possessions intact, the wealthier To demonstrate each tier of service, the embalmers would show three Egyptians requested deeper graves that could be sealed or lined with wooden models of corpses that were distinct from one another by the materials that would keep sand away from the body and grave robbers way the body was incised (or if it was not incised), the number of steps away from personal items, such as buried jewelry and even furniture involved, and the materials used. The most expensive (over $1,000, by that the upper class might want buried in their container. current monetary standards) required incision and removal of internal Even with sealed containers, grave robbers of the day, knowing that organs, as well as the insertion of aromatic powders and perfumes, valuable jewelry and personal objects were being buried with a body, such as myrrh, frankincense and cinnamon, before the incision was would find ways to open the containers and steal the items, usually sewn up. A less expensive method (less than $100) utilized an injection leaving the body in a position where it was no longer protected and of cedar oil into the gut or anus, while the cheapest included little more no longer preserved. Once discovered, bodies might be decayed or than washing and salting the body for a lengthy period. In most cases, even reduced to a skeleton, which was shocking to family members. the desirable processing time was a period of 70 days. Unaware of the process of decomposition, the Egyptians initially Our knowledge of the process comes primarily from descriptions thought that burying loved ones in tightly built stone coffins would written about 500 BCE by the famous Greek historian, Herodotus. preserve them. When they found that the soft tissues would disappear Nearly 500 years later, in 45 BCE, Siculus, another historian, even in a stone casket, they coined the term “sarcophagi,” which refers would write about the process – still the three tiers of service, but to a type of bronze or copper casket, but literally means “flesh eater.” materials and processes had changed slightly. Here are some of the characteristics that were common to both accounts.

Egyptian embalming procedure

The first step for the ancient Egyptian embalmer was the removal of The next steps were spicing and wrapping the body. The body surface the brain, typically with the use of a metal hook or spoon, inserted and cavity would be coated with resin (tree sap), or resin mixed with through the nostrils into the brain, or less commonly, through the eye fat, and the skull was packed with bandages made of linen and soaked socket. Some mummies did not have the brain removed. in resin, rolled up and placed in the cranium. Sometimes the skull was Incision and evisceration was not always used, but became more filled with resin that was heated and poured into the skull using a funnel. common in later periods. The earliest incisions were made in the left The viscera removed from the body might be returned to the body side, from the ribs to the crest of the ilium, measured about 5 inches, or placed in four special jars, perhaps one to two feet in height and and were usually made with a black flint knife blade. The angle of the 4 inches across, and made of a variety of materials, from clay to incision shifted over time, then turned oblique, with the cut extending alabaster. The top of each container depicted a face of one of the four from the crest of the ilium toward the pubic bone. Very late in the children of Horus, the Egyptian god of the sky, who had the body of a tradition, bodies might be incised at the anus. In cases of evisceration, man and the head of a falcon. Each child resembled a different species, all the viscera except the kidneys and heart were removed and cleansed, having the face of a human, jackal, hawk or ape, with each container then immersed in a container of palm wine and packed in natron. dedicated to a specific body part: the jar with the human face contained Natron is a salt found in dry lake beds of the desert in that area that is the liver; the face of a jackal held the stomach, an ape held the lungs composed of sodium carbonate decahydrate (a kind of soda ash) and and the hawk, the intestines. The jars were typically housed in a baking soda, along with small quantities of household salt. Like other wooden box near the body, while miniature copies of each of the four salts, it is highly corrosive. Egyptian embalmers found it necessary containers were placed within the body cavity. The cavity was then to tie fingers and toenails to each digit using a little metal wire or packed with straw, resin-soaked linen or moss. thimble, or the nail would disappear in this step of the process. The If the actual organs were returned to the body cavity, they would be body was immersed in a high concentration of natron for 20 days. wrapped in material that also depicted the appropriate child of Horus. After that, it was rinsed with water and dried in the sun. In the earliest days of embalming, the incision was not sewn closed,

Funeral.EliteCME.com Page 82 but the edges were pulled together, or attached to one another with Originally, Egyptian embalming was simply about preservation; keeping wax or resin. Embalmers began to sew the incision closed as early as the body from decaying. Only if a body was properly embalmed and 1700 BCE. Looking at the stitches today, one is struck by how much mummified would the individual be able to be part of the afterlife. they look like the familiar embalming stitches used in modern times. Given the prominence of death rituals and the fact that the quality Finally, the incision would be covered by a plate made of metal or wax of the embalming directly affected one’s chance in the afterlife, depicting the eye of the Egyptian god of the dead. embalmers were treated with great honor and respect, often In the most expensive method, treatment would approximate this accompanying priests at the temple in the role of holy men. In schedule: fact, during embalming, the head embalmer would wear a costume ●● Day 1 through16: Evisceration and washing of the body. depicting Anubis, the half-human, half-jackal god of funerary and ●● Day 16 through 36: Immersion in natron. embalming, who protects the dead for their journey to the afterlife. ●● Day 36 through 68: Spicing and wrapping with bandages. In the last 1,000 years these methods were practiced, the external ●● Day 68 through 78: Body placed in a coffin. appearance of the wrapped body became increasingly important. Wrapping started rather simply and became a very complicated affair, Wrapping patterns became more and more elaborate, with plaster with individuals specializing in the wrapping of toes, for example added to create a surface that could be easily decorated to depict the or another body part. Each finger and toe was wrapped individually, individuals’ life. A lifelike portrait of the individual was painted and followed by wrapping of each of the limbs. The face would be covered placed over the mummy’s head, with great care taken to make the face with a bandage and the body with a simple cloth garment, then spiral as close to the way it was in life. bandaging would begin. The body would be padded in places or Wrapped mummies were placed in a “cartonnage,” a kind of envelope bandaged with extra material to maintain the body’s natural shape. of about 25 sheets of linen or papyrus soaked in resin, plaster of Paris Other items might also be bound between the bandages, including the or gum acacia and placed over the body when still wet. This material name of the deceased or lotus flower petals. would be pulled together and cinched in the back create a tight fit that The amount of bandages required was great, and people may have dried to create a hard surface that would be covered with a thin layer saved pieces of linen their whole lives to have sufficient wrapping for of plaster that was painted with a human head or other images. The their mummification. Bandages might be over 3,000 feet in length and body within the cartonnage would also be surrounded by a number of were imprinted with hieroglyphics identifying the person. wooden boxes made of cedar or sycamore. The position of the body Ancient Egyptians did get what they paid for, in some cases, as the more in the coffin also changed with time. Initially, bodies were place in expensive methods of embalming preserved the body better, but only the coffin on their sides, with a pair of eyes painted on the outside of about 10 percent of mummies were preserved this way. The majority the coffin to signify the position of the body inside. The final external of people were embalmed using cheaper methods, where the body was container for the mummy varied according to the fashion of the day. coated with natron or heated resin, for example, which preserved the Early on, the outermost wooden case might be shaped like a house body but tended to destroy facial features, fingers, toes and hair. Some with a roof for a cover in one era. Later, it was more likely to be of the success of Egyptian preservative methods could likely also be shaped like a human form (called mummiform). attributed to a hot, dry climate that discouraged bacterial growth.

Ancient Egyptian restorative art

The ancient Egyptians were already practicing a range of restorative If the individual had a broken leg or other obvious disability or injury, techniques as early as 1200 BCE. To “round out” emaciated facial it would also be tended to. Bed sores were packed with resin-soaked features, such as hollowed cheeks, the inside of the mouth might be linen and covered with animal hide. Broken legs would be supported packed with sawdust. Eyelids were stuffed using linen or eyes might with a splint. A crooked spine might be straightened. be replaced with stone. Material was also packed into the body through Important or wealthy people’s bodies might be painted with a thin incisions into areas like the back, which could not otherwise be easily layer of gold (gilded). The gold might cover the whole body, or, more reached. Later, the temples and cheeks would be filled with warm resin commonly, portions of the body, such as the face, fingers, toenails and administered through a funnel into the ears, where it could be molded genitals. After this, the body would be covered with a sticky paste of into the right position. Common padding materials included long pieces fat mixed with resin, and bandaging would begin. of linen, sand or mud, sawdust, and fat. Both the face and the body were contoured to approximate the individual’s original features and shape.

Other ancient embalming traditions

While many ancient civilizations embalmed their dead, only a small Perhaps as early as 900 BCE, the Guanche lived in the Canary Islands, number are mentioned here to touch upon the great diversity of a small cluster of islands in the Atlantic Ocean. Fabled to be the methods and materials used. descendents of Atlantis, the lost continent, the Guanche embalmed Populations of the Tigris-Euphrates River Valley, including the Persians, only the most important members of their society, using a flint knife Syrians and Babylonians, submerged recently deceased individuals to cut the lower abdomen and take out the intestines, which were of importance in a container of honey or wax to preserve the body, cleansed and returned to the body along with salt and herbs, which also especially for a long journey. Alexander the Great was likely treated this covered the cavity. The body would be covered with fat, resin powder way to preserve his body after his death in battle in 323 BCE. and pumice, and dried in the sun or placed by a heat source, with arms positioned according to the body’s gender; men’s arms down at the The ancient Ethiopians eviscerated and dried their dead much like the sides, and women’s across the stomach. Guanche embalmers were Egyptians. They also practiced restorative art, applying layers of plaster also gender-specific – only male practitioners could attend to men’s to the skin to round out the body in natural contours. Then, the plaster corpses, and female practitioners to women’s corpses. was painted and covered with a thin clear coating. Its composition remains something of a mystery, but may be a type of liquefied amber. In some cases, the body was dried in the same manner described above, but, additionally, a corrosive substance, likely the juice of a local plant, was inserted into the wall of the abdomen or poured down the throat,

Page 83 Funeral.EliteCME.com producing a special type of mummy called “xaxos,” the knowledge of bones, leaving the skeleton intact, with the sinews still connected to the which may have originally come from Egypt. These mummies were bones. All the flesh was removed from the bones, and dried thoroughly distinct from others as the flesh of their bodies appeared perfectly in the sun. The bones and skin were also dried in the sun, but the skin preserved – wrinkled and a deep tan color, but forming a hard, dry, was painted with fat first to reduce shrinkage. After drying in the sun, unmovable surface. Xaxos bodies show no sign of decay, very minimal the skin was placed on a mat and housed in a special building on a high shrinkage in body size, and are incredibly light. A body measuring about shelf where it remained clean and undisturbed until the funeral. At that 5½ feet in length might weigh only 7 or 8 pounds. time, the bones were replaced in the skin and a powdery white sand Guanche embalmers were responsible for watching the body and was used to fill in the natural contours of the body. Once the skin was protecting it from vultures during the drying period of a little over two sewn up, the body was said to look much as it did in life, according weeks. After the drying was complete, the family would take the body to witnesses. The flesh that had been taken off the body and dried was with them and sew it a cover made from animal skin. Nobility were placed sewn into a basket and placed at the feet of the corpse. in hollowed out juniper logs, which served as coffins, and which were More than 100 years ago, the people of the Aleutian Islands and housed in special caves. Unlike Egypt, where embalmers had enjoyed Kodiak Archipelago preserved their dead by removing the internal high status, Guanche embalmers were paid well but suffered the taint of organs though an incision in the pelvic area, with the resulting cavity personal pollution by the nature of their work. Their touch was considered filled with dry grass. The body was placed in a cold stream where contaminating, and they lived far from the rest of the community. the icy water stripped the body of fatty tissues. The corpse would be Some indigenous North American populations (Native Americans) who manipulated into the fetal position, with the knees immediately under preserved the corpses of their leaders after death used a singular process the chin, and the arms wrapped about the legs. In some cases, bones in which the skin was removed all in one piece. The procedure began had to be broken to achieve this posture. Once formed into this shape, with an incision in the back, followed by removal of the flesh from the the body was dried in the sun and wrapped in animal skins.

Embalming during the Renaissance

During the Dark Ages (also called the Middle Ages), a historical be a speedy process, typically performed outdoors in the cold in front period lasting from about the 5th to the 15th Century ACE, the law of a large group of anatomy students or other spectators. The supply had typically prohibited medical schools from acquiring corpses for of bodies for study, however, never matched demand, and medical anatomical study and dissection. What was little known at the time students, along with many other culprits, were known to steal bodies is that cases of embalming, while few in number, did occur. Most of from cemeteries or the gallows and work with them for the short time the people preserved were royalty or held another elite status, such as before they were too decayed to be useful. members of the clergy. The information was kept secret, not known In 1300, Pope Boniface VIII issued an order that prohibited corpses by the typical European nor publicized in any way. The methods used being cut into pieces for transport or burial, warning that those who were very similar to the ancient Egyptian methods (and were likely broke the rule would be excommunicated. Now, those killed in battle taken from ancient descriptions in historical documents), except that needed to find a new way home, at the same time that anatomy the process was speeded up considerably. It was generally done to students needed a preservative that would allow a more careful and preserve the body for burial purposes, and was typically performed lengthy examination of a body without the worry of decomposition. where the death occurred. A pope, bishop, countess, and princess were among the elite group of individuals embalmed during the Dark Ages, It was clear that some form of drying the body would be necessary, and but this was not generally known until the 1500s. there had already been some experimentation exposing cadavers to the heat of the sun and ovens. It was also discovered that warm air pushed Within this period, from 1095 to 1291 ACE, the Christian nations of through the blood vessels would clean them out and dry the tissue Europe launched a bloody campaign, known as the Crusades, in an surrounding them. Additionally, practitioners had been experimenting attempt to capture the Holy Land, initiating a series of military campaigns with the injection of different substances into the body, which was against Moslems and many other religious and cultural groups. It was facilitated by the invention of better injection tools. Anatomy students a time when many, many members of nobility and military leaders learned to inject substances into body cavities to make blood vessels died in battle, far from their homes. As preservative methods were more visible for study, and in the early 1300s, in Italy, a colored unknown to the vast majority of people, bodies of importance would be solution that hardened in the body was developed. Others experimented disemboweled, and the flesh cut off. Bones were boiled until soft tissues with injecting warm water, ink, mercury and wax. came off the bones, and the bones would be dried and wrapped in animal hide, to be returned to their home nation by couriers. The first instruments used for injection included a bladder, which held the solution, attached to a cannula made from a straw, the quill of a The Renaissance, the historical period that emerged from the Dark feather, and later, a glass tube. The tubelike section would be inserted Ages, marked a period of increasing freedom in the study of anatomy in a body opening, and the liquid would be pressed out of the bladder and medicine, historically indicated when Frederick II, a Sicilian king and into the body. Tools approximating a modern hypodermic syringe in the early 1300s, granted authority for dissections to be carried out were manufactured as early as the 1500s. By the end of the century, the and even delivered a number of executed criminals to a medical school first continuous-flow syringe was developed. in Bologna, Italy, for the procedure. In those days, dissection had to

Early European embalmers and embalming methods

Ambroise Pare, who lived in the 1500s and was the Royal Military The embalmer treating soldiers killed in battle would first remove surgeon for two French kings, was best known for devising a method the heart, which would be embalmed separately, then presented to of embalming that become the most commonly used of the era. Like the relatives, as was the custom of the day. The skull was cut with a most surgeons of the day, he was responsible for embalming the bodies saw and the brain removed, and deep incisions were made along the of military men killed in battle or by natural causes, but he was also limbs and back and buttocks, where the larger veins and arteries are well known for developing a technique for controlling bleeding after located, to empty the blood, which was further pressed out. The body amputations and his ability to design far better artificial limbs than had was washed with a sponge soaked in aqua vita and vinegar boiled with previously existed. wormwood, salt and other ingredients. All the incised areas would be

Funeral.EliteCME.com Page 84 filled with an aromatic, powdery mixture of spices and herbs including Stephen Blanchard, also Dutch, published a book about dissection, chamomile, balsam, menthol, lavender, marjoram, thyme, absinthe, extolling on this new method of preservation called “embalming” in myrrh and sandalwood. The incisions would be sewn closed, and the a 1688 text that mentions the use of spirits of wine and turpentine as entire body would be covered with turpentine and rose and chamomile preservatives, with diagrams of the necessary instruments for introducing oil, then layered again with the aromatic powder. The body would be the liquid into the body. His first step in one of the descriptions requires wrapped in linen, and placed in a lead coffin, filled with dry sweet that the intestinal tract be flushed with water forced into the mouth and herbs. If the herbs were not available, a powder of lime and ashes out through the anus, followed by spirits of wine, which are blocked of oak wood could also be used. It was said this procedure would from flowing out the rectum and maintained in the body. Large veins and preserve a body for as long as was necessary. arteries were also opened and blood was flushed out with water, then also In the 1600s, two Dutch practitioners developed the method of arterial injected with spirits of wine. This the first written account of a technique injection to introduce a preservative substance into the vascular system. that includes the injection of the blood vessels for embalming purposes. Jan Swammerdam was trained in medicine but dedicated his career to Secret formulas for embalming fluids were not uncommon. A the examination of insects and small animals. He experimented widely successful Flemish embalmer named Ludwig De Bils was particularly with different substances, finally finding that a mixture of alcohols, secretive and concerned about his competitors stealing his formula. turpentine and wax created an effective preservative. Unbeknownst to him, one of these competitors, a German physician Swammerdam’s technique was applied to humans by Frederick named Gabriel Clauderus, visited De Bils’ anatomical museum and Ruysch, who used it to preserve entire bodies or parts of bodies, touched one of the preserved bodies with a moistened finger. Later, typically for use as teaching aids, but also, in some cases, to restore he tasted it, and found it had a salty flavor, suggesting a large portion high status individual’s bodies for funeral purposes. His skills were of the formula might be salt. De Bils never did disclose his methods, required, for example, when a famous British admiral was killed and Clauderus went on to publish a method of embalming that did not at sea near Holland and not recovered from the water immediately. require evisceration but used a mixture of “ashes of tartar” and “sal There was much concern that his badly decomposed body could not ammoniac” dissolved in water, a potion he called “balsamic spirit.” be preserved for travel or restored to a presentable appearance for the He would inject the fluid into all the body cavities and immerse the viewing at the funeral, but Ruysch was said to have done a masterful job cadaver for a period of up to two months, then finish treatment by restoring the body to a natural appearance and color. His refinement of drying the body in the sun or other heating source. Swammerdam’s techniques remains something of a mystery, and it is suspected that he may have used some amount of arsenic in his formula.

The British Isles

The British Isles developed different techniques than those most was layered on the viscera before closing the incision. The eyeballs were popular in the Netherlands. The Company of Barber-Surgeons, the pierced and emptied, then packed with the powder mixture, along with medical association of the day, was given the sole authority to embalm the mouth and ears, then the skin rubbed down as above. and perform anatomical dissection in England, but others also engaged In the mid-1800s, John Morgan, a professor of anatomy at the in the practice. University of Dublin in Ireland, formally established two principles for William Hunter was born in Scotland but found success as an producing the best embalming results: injection of the solution into the obstetrician in London, where he was appointed physician-extraordinary largest artery possible and use of pressure to push the solution through to Queen Charlotte of England in the mid-1700s. His most critical advice the blood vessels. He also was among the first to make use of a pre- for students was to begin the embalming process within eight hours of injection solution as well as a controlled drainage technique. Morgan’s death in the summer and 24 hours in the winter. He taught the following method required that the body be opened so the heart was visible, embalming method for purposes of funeral viewing and anatomical study: then an 8-inch pipe was inserted into the left ventricle or aorta. The The first step was injection of the femoral artery with a combination pipe was connected to yards of tubing ending in a fluid container hung of “oil of turpentine,” “Venice turpentine,” chamomile and lavender above the corpse. The force of gravity acting on the liquid above the oil, and vermilion dye, used until the skin took on a rosy appearance. body would exert about 5 pounds of pressure, adequate to the purpose The body would remain untouched for a few hours, after which the of permeating the body. thoracic and abdominal cavities were opened, the viscera removed, By the later 1800s, a number of embalming methods were becoming and the liquid pressed out of them. The viscera itself would be more common in other parts of Europe. In Italy, the practitioner injected and immersed in camphorated spirits of wine, then returned Tranchina, from Naples, used and promoted solutions using arsenic, to the body along with a powder made of camphor, resin and niter. which he injected into the arteries for funeral viewing and anatomical This powder would also be inserted into the eyes, ears, nose and study. He typically used 1 pound of arsenic mixed with 5 pounds of an other cavities. The skin of the entire body was rubbed with rosemary alcoholic wine, some of which would be injected into the femoral artery and lavender oil and the body was placed on a bed of plaster. Bodies without any previous removal of blood. In some cases, he injected the used for anatomical study would be placed in a box for a period of fluid into the right common carotid artery so that the solution would about four years and checked for decomposition. If some was noted, permeate the head as well as the body. The lungs were filled by way of the body was placed on a bed of gypsum. the trachea. He would also incise the abdomen to empty the bowel and Both Hunter’s brother and nephew were also prominent embalmers. moisten the area with the preservative solution. According to records, The nephew, Matthew Baillie, modified the methods used by his uncles the body would be completely dried in six weeks. to provide comparable preservation in a shorter period of treatment. He used the same solution, similarly injected into the femoral artery, then left undisturbed a few hours. At that point, however, he made a small incision in the bowel and introduced water through a small tube to wash out the contents of the bowels. He also ligated the rectum and small bowel and filled the intestinal tract with camphorated spirits of wine. The lungs were also filled by way of the trachea. The bladder was emptied and refilled with a powder of camphor, resin and niter, and it

Page 85 Funeral.EliteCME.com Gerolamo Segato of Florence, Italy, was said to have turned a human a complicating factor in a high-profile murder case in which arsenic body to stone by introducing silicate of potash into the body tissues, was thought to be the poisoning agent. Additionally the medical followed by immersion of the body in a weak acid solution. The specific community was concerned about the potential risk of poisoning to details are unknown, but the story appears to have a factual base. people handling the body. Jean Nicolas Gannal, who began his career as a pharmacist’s assistant, In the mid-1800s, J.P. Sucquet advocated the use of zinc chloride as became a highly revered inventor and expert in the field of chemistry. In a preservative, using about 5 quarts of a 20 percent solution in water, 1831, it was requested that he find an effective way to preserve bodies which he introduced into the body through the popliteal artery and for anatomical study. After much experimentation, he found a formula the abdomen. Rights to this very successful method, proven to keep a of 6 quarts of a solution of aluminum acetate, administered through the buried body in excellent condition for at least two years, were sold to carotid artery, preserved the body without the need to drain blood or two Americans, Charles D. Brown and Joseph Alexander. eviscerate. In some cases, the bodies would be immersed in this solution Richard Harlan, an American medical doctor who met Gannal, and until they could be dissected. When used for funeral presentation was presented with his book, “History of Embalming,” was so taken purposes, the process was the same, except that Gannal would add a with it that he requested permission to publish the book in English in small amount of arsenic and carmine to the original solution, about the United States. Embalming practices traveled relatively quickly 2 gallons of which would be injected upward, then downward, in the from Europe and the United Kingdom to the United States, in part carotid artery. A number that were disinterred over a year later were said due to the publishing of Gannal’s book in Philadelphia in 1840, and to be in exactly the same state as on the day of burial. in another part due to the fact that Sucquet’s embalming methods Gannal worked on a number of famous cases for the Paris police, and materials had been purchased as a business venture by two savvy preserving murder victims so that some information about the death or doctors from New York – Brown and Alexander. Most significantly, the murderer might be discovered. He was also associated, indirectly, however, the history of embalming in the United States was changed with the passage of the first law prohibiting arsenic in preservative by the onset of the Civil War, in the year 1881, which increased the materials, which occurred in 1846 when his use of arsenic become demand for an effective way to preserve bodies for funeral purposes.

Early American embalmers and embalming methods

At this time, in the U.S., there was almost no embalming of the dead with a variety of different chemicals and embalming techniques. for funeral purposes. Preservation of the body typically meant the He developed a very effective solution (which he later marketed as use of ice, which required cold weather. At the beginning of the Civil “Innominata”), that he used to embalm the first prominent military War, no plans were provided for returning the fallen to their homes. In figure killed in the war (in 1861), a young colonel named Elmer previous battles against the Native Americans and during the Mexican- Ellsworth. Funeral services were held in three different cities, requiring American War (1846-48), the military dead were buried where they that the body travel a lengthy distance before burial in a fourth city. fell in battle. In the early days of the war, family members were able to His appearance was discussed favorably in the press, providing a good claim the deceased by themselves by going to the hospital or battlefield introduction of embalming to a previously uninformed public. and bringing the body home for burial. When battles were far from the This series of viewings of the body became something of a tradition, troops’ homes, the process of returning the body to the family became and was repeated with other war heroes, culminated with slain far more difficult. In some cases, the remains would be returned to President Abraham Lincoln. Holmes also embalmed the next colonel family members if they had formerly requested it and could arrange who died in the war. His body also toured the country to be viewed the transportation of the remains back to the troop’s home state, but with great publicity before the funeral. By 1864, all deceased patients this was often a very difficult thing to accomplish. at the Washington, D.C., Military Hospital, Holmes’ headquarters, At the same time, there was great concern about the dangers of contact were routinely embalmed and the grave marked so that the body could with dead bodies and fear of contamination. People who worked with be disinterred and sent to the family, if desired. decomposing bodies in cemeteries and churches became ill, but no In all, it is estimated that Holmes prepared more than 4,000 bodies one understood the mechanism by which this occurred. Embalming, during the war. it was thought, would make handling corpses a much safer venture. Concerned with these issues, President Lincoln directed the troops to After the war, Holmes turned to business, selling “Innominata,” his use embalming to allow the return of the Union dead to their homes. embalming solution, to interested undertakers. While he found that As it never became a policy in the South, virtually all those embalmed undertakers were intrigued by the preservative qualities of his product, during the Civil War were Northerners. they did not have the surgical skills required for common embalming techniques. Holmes, followed by others in the field, found that they Initially, the process for embalming called for arterial embalming when could sell more of their product by emphasizing its disinfection possible, usually injecting the femoral or carotid, without drainage qualities, the fact that it could be used for external applications, such or any cavity treatment. If the nature of the wounds or degree of as washing the body and face, and could also be easily poured into decomposition made arterial embalming impossible, the trunk would the mouth and nose to permeate the lungs and stomach. Holmes also be eviscerated (if necessary) and refilled with sawdust or powdered patented many embalming-related inventions, such as a canvas corpse charcoal or lime. Then the body would be placed in a coffin entirely removal bag that was coated in rubber, and an innovative injection filled with sawdust for transport home. method that improved on the hypodermic syringes currently available Embalmers of the time utilized a variety of methods and solutions that needed constant refilling. In some cases, a pump that provided and manufactured all their own chemicals, including arsenic, zinc continuous flow would be used, but it was rare during this time. chloride, bichloride of mercury, aluminum salt, sugar of lead, and a Dr. Richard Burr became famous as the embalmer photographed variety of salts, alkalis and acids. To make zinc chloride, practitioners by Matthew Brady in front of an embalming tent near the battlefield. would immerse sheets of zinc in hydrochloric acid until the necessary Despite this claim to fame, Burr had not been happy with Brady’s solution was achieved. presence, even accusing him of accidentally setting fire to the Dr. Thomas Holmes, born and educated in New York, became one embalming tent. Unfortunately, Burr, along with a number of other of the most well known names in the field through his experience in embalmers employed by the military, also gained a reputation for the war. As a coroner’s physician in the 1850s, he had experimented poor service and inflated costs, according to many complaints. In

Funeral.EliteCME.com Page 86 response, Gen. U.S. Grant ordered that all embalmers be excluded ●● Daniel Prunk went to college and medical school in Ohio, practiced from military areas until he had come up with a reasonable set of rules medicine for a number of years, then signed up for service as an and regulations, which became the first step toward the licensing of assistant surgeon for the Volunteer Infantry in 1861. Licensed by embalmers and undertakers. the army in 1865 to practice embalming and undertaking, he set up A U.S. Army General order stated that only those with special locations in Tennessee, Georgia and Alabama. Prunk’s embalming licensing by the army would be able to remove bodies from the field formula used zinc chloride, to which he added arsenious acid, or embalm. Those who wanted to work as embalmers for the military which was injected warm with no dilution or blood drainage. had to post a performance bond and had to furnish a list of prices for Prunk wrote one of the earliest descriptions of cavity treatment that materials and labor to the appropriate military officials. Applicants for advised puncturing the stomach to allow gases to escape, especially license were also required to describe the process and materials used important, he noted, when shipping a corpse a long distance. He as well as the length of time the preservative would be effective, and also recommended that an individual with a large abdomen and documentation or evidence to support their claims. discolored bowel have fluid introduced into the peritoneal cavity, and described an ingenious method of using a silk string like a In some places, specific prices were dictated. For example, in drawstring to close the cavity once injection was complete. Tennessee and Alabama, the following fees applied: ●● Benjamin Lyford was an embalmer during the Civil War who “Embalmers must post a bond of $1000 guaranteeing skillful patented a complicated embalming system in 1871 that required performance of work. Disinterment (only between the middle of that the body be enclosed in a sealed container that would be October and the middle of May) for a price of $15. Furnish metal emptied of air by a pump. He was one of the first embalmers to burial cases, marked and dropped off for express service for a recommend that cosmetics be used to normalize the facial features. price of $75. Zinc coffins an additional $40.” ●● G.W. Scollay patented a method of embalming just after the Civil The following men are a small number of the many innovators who War that involved the use of gaseous compounds injected through contributed to the evolution of embalming around this time: the vascular system, and was one of the earliest proponents for a gaseous rather than liquid preservative.

The early profession

The Civil War and assassination of President Lincoln had familiarized fluids would also instruct you in the technique of arterial embalming. the general public with the concept and appearance of an embalmed They might sell other items also. Here is a list of prices for embalming body, but embalming was still comparatively rare. The profession tools and materials from 1877: was poorly organized, had no formal schools or training programs, ●● Rubber gloves – $2 pair. with little uniformity in embalming techniques. Patents for chemical ●● Anatomical syringes with three cannulas in a case – $22. embalming fluids showed that many used mercury and arsenic. ●● Surgical instruments in cases – $5. Most companies employed traveling salesmen who also demonstrated ●● Wax eyecaps and mouth closers – $1 each. the products they were selling. The man who sold you preservative ●● Embalming fluid – $5 for 12 pint bottles (might also be available in 10-gallon kegs at $3 per gallon).

Noted embalmers and publications

Until the early 20th century (the 1900s), embalming usually occurred cooling rooms. These magazines, which also presented advertisements in the deceased’s home, or perhaps at the hospital. But as early as the for embalming products and tools as well as articles of interest to those 1870s, two professional journals, The Sunnyside, established in 1871, in the funerary business, depicted the funeral home of the future as one and The Casket in 1876, highlighted funeral homes that had morgues that would meet a range of needs, a place for preparation of the body, with appropriate facilities for embalming, including running water and viewing, services and burial.

Renouard

Dr. August Renouard, a regular contributor to The Casket and In 1880, Michigan became the first state to form an undertakers eventually renown as an embalming expert, was originally a bookkeeper association. In 1881, it changed its name to the Funeral Directors for a furniture store and undertaking establishment in Colorado. Association, and other states followed, organizing similarly under the Renouard was responsible for the transportation of bodies back east and same name. In 1882, representatives from all the state associations south for burial and soon saw the need for an effective way to preserve met in Rochester, N.Y., and formally founded the National Funeral bodies. He requested permission of his employer to arterial embalm the Directors Association, a significant step in the professional growth of bodies before shipment, and his work received instant acclaim from the the field. Renouard himself provided demonstrations of embalming at undertakers around the country receiving the bodies, which, it was said, the first national convention, which set the precedent for embalming appeared to be sleeping. Renouard was not shy about marketing his demonstrations at state and national meetings afterward. chemical formulas and methods, and it was not long before undertakers In 1894, Dr. Renouard moved to New York City and founded the U.S. around the country were happily purchasing his products. College of Embalming. The school was unusual in that each student Renouard developed a popular correspondence course and provided would remain enrolled until he was able to embalm with what were personal instruction in embalming, but no instructional textbook of considered sufficiently professional skills. Renouard’s son, also an undertaking and embalming was yet widely available in the U.S. embalming instructor, worked at the training school for many years. Because of his expertise and public acclaim, the management of The Renouard’s special embalming fluid, it was advertised, would not Casket asked him to write a book that could be used as a practical harden the body, but would make it firm and preserve features in a guide. “The Undertakers Manual,” published in 1878, was a detailed lifelike manner, providing a natural color to the face. Further, it was 230-page compendium of anatomy, chemistry and embalming noted, the solution was not affected by freezing, would not injure the information, with instructions on practice and descriptions of available hands, was a powerful antiseptic and disinfectant, and contained no instruments and equipment. arsenic, mercury, zinc or formaldehyde.

Page 87 Funeral.EliteCME.com Clark and Sullivan

Joseph Henry Clark, born in Indiana in 1840, was initially employed Sullivan was never in one place of employment long and was known as a casket salesman who began to sell embalming fluids as a to have a volatile temper, but became famous as an expert embalmer in sideline. He found sales were greatly facilitated by a demonstration a number of famous and difficult cases. A “mad bombing” in Chicago of embalming methods, as it helped end-users understand how to that took a number of lives required Sullivan to restore members properly utilize the materials to get the desired effects. He enrolled of the police and one of the bombers, who had had a dynamite cap in an anatomy course in Cincinnati to begin learning the necessary explode in his mouth. The other bombers were hung, and all the dead information, working closely with a Dr. C.M. Lukens, and eventually were prepared by Sullivan, who was highly praised for their natural founded the Clarke School of Embalming at Cincinnati in 1882. appearance. Sullivan lectured and demonstrated embalming before Initially, the school was more like a traveling show, as Clarke traveled large classes in many cities, but was censored for a period after he most of the year, providing instruction around the country. In 1899, the was found in a compromising situation with a woman who was not his school’s name was changed to the Cincinnati College of Embalming, wife, and was charged with wife and child desertion. After treatment and Clarke became a permanent lecturer at that location. He was for alcoholism, he returned to a successful career. considered an excellent instructor and writer, and held a number of Clark and Sullivan disliked each other intensely, at one point becoming patents associated with embalming. enmeshed in a heated conflict regarding Ulysses S. Grant’s embalming. Felix Sullivan, born in Canada, was the son of an undertaker who Clarke had been contacted to handle the embalming by the undertaking came to the United States to enlist in the New York Calvary during the company arranging the funeral, but was ill on the day of the death and Civil War. Deserting service near the end of the war, Sullivan worked bedridden for a number of weeks. Another member of the undertaking for a number of casket companies in New York, eventually becoming company completed the embalming instead, using Clarke’s proprietary a funeral director and studying anatomy, then a skilled embalmer. embalming chemical. After the body was embalmed, Gen. Grant’s Sullivan saw how successful Clarke’s course had become, and enrolled clergyman and Felix Sullivan arrived and insisted the body be re- in it in 1882, then proceeded to create his own course of instruction embalmed. Sullivan claimed to pull out all the fluid previously injected patterned after it, which also sold successfully. He became Clarke’s and replace it with the fluid made by the company he represented. greatest rival. Sullivan was also called in to re-embalm President Garfield after the first procedure was considered inadequate.

The Dodge family

Two brothers, George and A. J. Dodge, originally in other businesses, A.J.’s previous training in chemistry made him aware of the found themselves the owners of the Egyptian Embalming Chemical importance of research, and he was always thinking of ways to Co., in repayment of a debt owed them. They took to the new venture improve existing products and techniques. In 1921, his company with interest, studying anatomy and chemistry, then deciding to go began publishing an industry journal called The Dodge Magazine. to Boston to learn embalming. Both became practitioners, with A.J. Dodge seminars soon became important parts of many funeral director becoming particularly well known as an embalmer, teacher and author and embalmers’ educations, and introduced the idea of a full-service of embalming texts. funeral home. A.J. Dodge’s son, Walter, opened the Dodge Chemical In 1839, both brothers resigned from the Egyptian Chemical Co. and Co. in Detroit at the same time his father was opening one in Boston. purchased the Oriental School for Embalming, a traveling school A younger son joined as a salesman, and the company expanded, with headquarters in Boston. Two years later, the Oriental school was branching into all parts of the U. S. as well as Canada. By 1982, it renamed the Massachusetts College of Embalming. A.J. eventually existed in Mexico, Europe, Australia, New Zealand and Japan. left that institution to found the New England Institute of Anatomy, Sanitary Science, and Embalming, a nonprofit educational institution.

Other noted embalmers

The early 1900s saw the first significant move toward creating the artery or vein, and pressure could be increased further by pressing systematic treatments for unsightly injuries or disease. Around this the bag. He also developed the “Kant Slip Arm Plate,” a tube holder time, a New York embalmer named Joel E. Crandall developed a and shut-off device in one, which strapped to the arm below the point restorative art technique specific to head trauma that was adopted into of incision to hold the arterial nozzle and rubber tubing in place. some embalming program curricula. He will be discussed further in While women were much less likely to be employed outside the home the section, “Restorative Art,” below. in this era, embalming was not an uncommon profession for women, Carl Lewis Barnes was born in Pennsylvania to an undertaking with a number reaching great prominence in the field. The Bernard family. He manufactured embalming chemicals, studied medicine School of Embalming in New Jersey was founded by Mrs. E.G. and eventually opened an embalming school, but is probably best Bernard; Linda D. Odou founded the Odou Embalming Institute in known for his invention of a number of embalming tools, including the New York City; and Lena R. Simmons founded the Simmons School “handless injector” system. This contraption consisted of a collapsible of Embalming in Syracuse, N.Y. rubber fluid bag, hung in such a way that gravity would force fluid into

Funeral.EliteCME.com Page 88 Modern inventions

Since the development of arterial injection of the blood vessel in and “throat cutters” who chose to embalm arterially. Unfortunately, late 17th century, little else has proven more effective to prepare the both systems might fail singly, but would successfully work together, body. There have, however, been experiments with a great variety of so, eventually, the two systems were combined, with initial arterial methods and materials. In one “shocking” method, electric current was injection followed by treatment of the cavity. applied to a corpse in attempts to mimic the effect of lighting. It was As more embalming was performed in the funeral home, more not a success as a corpse apparently does not effectively conduct an professional devices became widely available. The vast majority electrical current and therefore cannot produce the contraction of small of embalming pumps or injectors in the late 1800s utilized gravity. muscles that might restore normal color to discolored areas or prevent One popular device was the gravity bowl, which utilized a container further blood coagulation, as was hoped. hung above the body and connected to the arterial tube with rubber A machine that vibrated the body to facilitate the removal of blood tubing, with the height of the bowl determining the amount of pressure was a sensation for a short time, but sometimes had the disadvantage exerted. Unlike the hand pump, which required constant manual of moving the body from one end of the table to the other, or shaking pumping, the gravity bowl could be continuously filled, and therefore instruments so violently that they could not be useful. did not require the constant attention of the embalmer or an assistant. Early in the days of modern embalming, with the advent of arterial By the mid-1930s, electric-powered injection machines were popular, injection, there was some concern about the trunk viscera. Should it with the fluid often gravity-fed to the pump. These machines were be removed and preserved separately, then replaced? This typically increasingly substantial, often made of metal and culminating in the required immersion of the organs in a preservative powder or liquid, “Porti Boy,” in 1939, the most popular injection machine in history, and additional powder or liquid placed in the cavity after replacement only to be surpassed in the 1960s by extreme high-pressure injection of the organs. The alternative method was to keep the trunk intact and machines, such as the Sawyer. treat it with the same preservative solution, introduced directly into the New embalming equipment, such as a battery-powered electric pump trunk cavity as well as through immersion of the body in the solution. that injected embalming chemicals, a jaw closer, and a plastic screw- In the mid-1870s, the invention of the trocar by Samuel Rodgers like device called a trocar button were invented in the first few decades helped to usher in a new system for treatment of the cavities. The of the 1900s. The trocar button successfully provided a waterproof seal trocar was patented in two forms, with the latter issued specifically for for trocar punctures or more exotic wounds, such as bullet holes. a system of embalming that included the introduction of the trocar into As embalming in funeral homes become more common, more were the naval so that a preservative could be distributed to all the organs of designed with a reliable water source that could be used to create the the trunk simultaneously. Rodgers also suggested the cavity treatment necessary suction for aspiration. In many cases, a trocar was connected be followed by injections into the limbs, also using the trocar. The to rubber tubing that was attached to a sink faucet. In the 1950s, these trocar’s ease of use made it appealing to those who felt uncomfortable methods were abandoned in favor of electric aspirators that provided performing arterial embalming, which required more anatomical more reliable suction and pressure than water, which might lose knowledge and dexterity. For a brief time, there was some conflict pressure in periods of high water use. between the “bellow punchers” who treated the cavity with the trocar,

The pros and cons of formalin

The use of highly poisonous chemicals with attractive characteristics As embalming moved from the bedroom to the funeral home, there has long been debated in the field of embalming, with many choosing were better ventilation systems and more refined formaldehyde to expose themselves to an unknown degree of risk. At the end of solutions to address some of these early problems. Increasingly, the 1890s, embalming fluid advertisements were introducing the specific formulas of preservative were developed for specific uses. In ingredient formalin, a saturated solution of formaldehyde combined the 1980s, a number of national organizations developed regulatory with other ingredients. While not wholeheartedly welcomed, it became guidelines for the embalming industry. The Federal Trade Commission the standard, while other preservatives with appealing but dangerous (FTC) and Occupational Safety and Health Administration (OSHA) qualities, like mercury and arsenic, were prohibited. adopted rules regarding embalming procedures, and OSHA provided Certainly, formalin formulas had drawbacks: Formalin-based fluids, regulatory guidelines outlining necessary protection for funeral home embalmers soon learned, required special handling and use to provide personnel. The Environmental Protection Agency (EPA) also regulated the desired results. For example, blood had to be removed and washed the industry, issuing rules concerning the use of formaldehyde by out of the body before injection of the preservative. Also, they found, embalmers. Because of the potential risk of formaldehyde to the safety it was critical that the body be properly positioned before the injection, of those who work with it, there is a long history of investigation into as hardening made it very difficult to model the hands or limbs into a other materials or methods that preserve as well. While a number of natural position. In cases of jaundice, formalin might react with bile to companies claim to have found alternatives to formaldehyde that are produce green skin. equally effective, none appear to have taken its place. The primary criticism of formalin fluids, however, was the concern A recent study published in the Journal of the National Cancer Society associated with inhalation of formaldehyde fumes, which commonly reviews new data regarding formaldehyde exposure and is currently caused mucosal irritation, or formaldehyde absorption though the skin, prompting all the regulatory agencies listed above to review and revise which was known to cause skin irritation. Other potential risks were their guidelines for formaldehyde exposure in the workplace (see Part relatively unknown at the time, but it was assumed that environmental II: Is Embalming Dangerous?). management of the workplace (better ventilation, use of gloves, masks, and so on) could reduce known risks to a reasonable level.

Page 89 Funeral.EliteCME.com A formal curriculum

As funeral services became more encompassing and funeral homes the bereaved, standardization in materials and techniques became more common, commercial companies developed to meet the new a priority. By the early 1900s, schools of mortuary science were needs of embalmers and funeral directors. The research in this just beginning to develop a common standard for coursework and subject area was typically referred to as “mortuary science,” with examination. It was also about this time that the first dedicated the discipline developing to such a degree that by the end of the embalming schools opened. 1800s, trade journals with technical and marketing information were In 1927, the first mortuary school accreditation was created by the surprisingly widespread. Chemical companies employed lecturers Conference of Funeral Service Examining Boards, a collection of the and demonstrators as salesman, and, throughout the 1800s, many existing state licensing boards. The National Council on Mortuary undertakers who wanted to learn to embalm did so by taking a period Education was established in 1942 by the National Funeral Directors of a few days to attend sessions of traveling schools, sponsored by Association and the National Association of Embalming Schools and these embalming chemical companies. These courses typically covered Colleges. Basic course content for anatomy and embalming and the only the most basic skills, given the short amount of time. Many mortician’s oath were initially drafted in 1948. The development of undertakers also turned to home-study courses. standard curricula was complicated by the fact that each individual, After the Civil War, training often occurred in funeral homes through trained in a different manner, might complete a task in a different a type of assistantship or apprenticeship. Each funeral home might fashion with different tools and materials. Review is ongoing to assure experiment with its own materials, tools and techniques, passing to the greatest extent possible that only the safest, most effective down what worked in a system of trial and error, with many unique products and methods are used. The American Board of Funeral Service systems. To ensure safety in the profession as well as satisfaction for Education continues to review and amend the required course content.

Modern restorative art

Modern restorative techniques (renamed “restorative art,” in the 1930s) preparations, false hairpieces (including prefabricated mustaches and became an important sub-discipline of aftercare services in the early eyelashes), and preformed wax facial features that could be modified 1900s, filling a critical need in cases where the body exhibits obvious by less skillful embalmers or technicians. signs of trauma or disease, or battle wounds from war. Modern restorative Crandall’s first step in restorative work was always to study a recent art plays a role in comforting the bereaved by presenting family members photograph of the deceased. One of his most famous cases was Col. with a loved one who appears as familiar in death as in life. Jacob Astor, a passenger on the Titanic. He and others pulled from the In 1912, the subject gained a name and a formal progenitor in an sea in 1912 were taken by way of Nova Scotia to New York for burial issue of the New York Sunnyside, a popular trade journal of the day. services. Given the amount of time the body was in the water and the Joel E. Crandall, a well-known embalmer, introduced “demisurgery,” delay in treating the corpse, the job was substantial. Crandall was able which he described as “the art of building or creating parts of the body to restore Astor’s discolored face to a natural appearance with the use which have been destroyed by accident, disease, decomposition or of cosmetics, allowing the casket to be open for viewing. discoloration, and making the body perfectly natural and lifelike.” By 1913, Crandall owned a demisurgical supply company, a school Increasingly, the science of demisurgery became a necessary part of in New York City and an undertaking company in New Jersey. Over the funeral professional’s toolkit. Five years after Crandall introduced the next decade, he lectured on the subject of demisurgery at the the service in the Sunnyside, another professional journal, The Casket, Demisurgical Institute of New York and developed a correspondence noted the necessity of making bodies “presentable” as an integral part course. In 1917, some of Crandall’s restorative techniques were filmed of the responsibilities of the embalmer and referred to Joel Crandall as to be shown at conventions for teaching purposes. This led to a popular the only person competent to teach the necessary techniques. lecture circuit. Unfortunately, much of this information has been lost Initially, Crandall was simply a traditional embalmer, albeit a highly or was never formally published. skilled one. In his early 30s, he began to record his experimental A number of embalming schools at the time claimed to teach aspects methods in repairing mutilated bodies, techniques he had refined over of restorative arts, and some argued that Crandall was not the founder the past decade. Initially, he had used materials common to funeral of the science of demisurgery, as he claimed when he opened the sciences at the time, such as plaster of Paris, but found it inadequate for Demisurgical Institute of New York in 1918. Schools in Boston, his needs. While it could be used to fill deep underlying areas close to Cincinnati and New York stated that the subject was a part of their bone, it could not be used as he wanted, to fill in damaged or missing curricula for years, although, if it was covered, it was not promoted skin. Instead, Crandall learned to create waxy putties and concealing in any of the advertising or published list of subjects covered until cosmetic preparations to mimic the look of intact healthy skin. 1912. By that year, Crandall was already an established leader in the His early work focused on bodies mutilated so beyond recognition field, lecturing on demisurgical techniques at the New York State that family members and undertakers usually felt they could not be Embalmers Convention. viewed. Largely by trial and error, Crandall addressed the problems Called names including “dermasurgery,” “plastic surgery,” “plastic encountered in mutilated bodies with solutions that are used, with work,” “derma sculpture” or “artistic embalming” (“demisurgery” some adaptation, to this day. One of his learning methods made use of was too closely associated with Crandall’s empire), many prominent plaster “heads” that were damaged and repaired, a practice adopted by embalming schools began to teach courses on restorative techniques, embalming school laboratories and used until quite recently. providing information on decoloration and specific postmortem surgical While Crandall may not have been the first to use hidden stitches to procedures. Not everyone in the field of funeral services agreed. C.A. close cuts or remove pieces of skin or other tissues that interfered with Renouard, for example, felt, as a matter of principle, that cosmetics the natural presentation of the face or body, he was among the first to and, in many cases, surgical procedures should not be used. Many formally include such methods in the category of restorative technique. years later, however, near the end of his life, he changed his mind, even Part of his skill was due to his manufacture and development of recommending courses in restorative art to students and colleagues. innovative instruments and materials, including a demisurgical grip While specific details of Crandall’s techniques are incomplete, it that included a set of basic instrument and brushes as well as cosmetic is likely his influence that spurred many embalming schools to

Funeral.EliteCME.com Page 90 incorporate some type of restorative art into their curriculum, as it create molds. It was as close to a custom fit as could be achieved, given became more expected and desired by consumers. By 1918, effects the very similar size and shape of features in most families. of World War I were causing people to ask whether demisurgery had Some methods developed early in the 1900s are still used today, applications for U.S. war casualties. Crandall felt that all war dead while others became outdated almost immediately. Methods that once should be embalmed as soon after death as possible, so they could be suggested great promise, such as skin grafting from one part of the restored later at the necessary time and place for a memorial service. body to another, never worked as well as hoped. In 1926, the Montez One of the most striking impacts Crandall made in the field was his Manufacturing Co. in Michigan developed an electric-heated spatula use of before and after photographs, showing his repair of mutilated meant for smoothing and modeling wax and reducing body swelling bodies. Numerous cases were quite severe, requiring substantial that held great promise but failed on both counts. It not only tended reconstruction. While an inspiration to many in the field, showing just to make the skin surface too shiny, it also was ineffective in reducing what could be achieved, there were also those who found the results swelling tissues. Most practitioners went back to their previous so impressive that competitors accused him of doctoring the photos. method, which required a bowl of hot water and an alcohol lamp to Crandall was incensed by this accusation, requiring all individuals heat the spatula to the desired temperature. This too had drawbacks, as involved with the restoration (including family members, lawyers, it became hard to control when it cooled, which would cause wax to the undertaker and photographers, among others) to sign affidavits roll and lose its adhesive ability. attesting to the authenticity of the photographs. The majority of prominent figures in the field in these early days Crandall’s other great contributions to the field were his confident agreed on only a few basic points. Most recommended use of a highly knowledge that a great many “unpresentable” cases could be restored concentrated fluid and completed basic restoration before arterial to viewing condition, as well as his innovations in materials and injection, and taught that a significant waiting period was necessary techniques. The first half of the 20th Century saw a growth in the between the completion of arterial treatment and final cosmetic number and types of products and equipment available, sold by application. The field was still highly experimental and flexible, with innovative marketing techniques such as before-and-after photos, virtually no standardization. as well as demonstrations and lectures, like those that had been Due to the prevalence of jaundice in the early 1900s for a period of used to promote embalming decades before. Many in traditional about a decade, there was much in the literature about the difficulty embalming considered the subdiscipline a new art form, and interest in in preparing a body with jaundice. The most commonly used arterial demisurgery, its tools, materials and especially cosmetics soared. fluids were formalin-based, and turned the body from the original Sales of prefabricated (usually wax) features and assistive materials and jaundiced tone of yellow to green once embalmed. While there may tools boomed in the late 1920s and ′30s, with a number of companies still be complications with a jaundiced body even today, the issue vying for Crandall’s business. These products, such as Eckel’s “molding has been addressed a number of ways, with more or less success. masks,” included generic prefabricated eyes or noses that required Bleaching solutions such as phenol and chlorine have been tried, but the individual responsible for the body to do some shaping based on one of the few early successful treatments (according to some) was a photo. In the late 1940s, a dental plastic surgeon and instructor of a treatment by J.H. De Normandie of New York in 1924, who used a restorative science suggested that a better match for many features secret solvent injected into the carotid artery combined with a topical could be achieved through the use of family members’ features. In other ointment and the use of hot moist towels on the face. The formula was words, siblings or parents who resembled the deceased could be used to never revealed.

Famous names, publications, and inventions in early restorative art

In 1915, Albert Worsham demonstrated the use of cotton and collodion seminal work, published in the early 1930s, is C.O. Dhonau and to fill shallow cavities and build facial features, all of which would G. Joseph Praeger’s “Manual of Restorative Art,” which was also then be covered with a layer of wax. Worsham’s claim to fame was updated in 1955. the restoration of a mangled lion tamer in 1917, in which he had to In the 1930s,Worsham designed a course including about 30-40 hours recreate ears, much of the facial features and both arms, as well as close of laboratory work that employed mutilated human heads previously the ripped-open abdomen. The same year, C. O. Dhonau developed used in anatomy and dissection courses. Between classes, these items a treatment for addressing swollen or black eyes by pressing out the were stored in preservative fluids, providing real conditions for practice collected blood using a slit on the underside of the lids, then applying a in filling cavities, forming facial features and applying cosmetics. 50 percent phenol mixture to lighten the area and shrink swelling. Almost two decades later, in 1948, lab materials had evolved, with the By the mid 1920s, articles on restorative art appeared frequently in Postgraduate Institute of Restorative Art of Chicago using specially professional journals associated with embalming, those of chemical created “mutilated heads” crafted from rubber and plastic, which manufacturers and other vendors. A number who contributed to the allowed students to suture, apply wax and cosmetics in a realistic way. technical literature were C.F. Callaway, who, starting in 1927 wrote many Increasingly, institutions of mortuary science provided more hours of articles, lectured on and demonstrated restorative techniques, as well as restorative art, but special schools devoted to cosmetic preparation and William G. Collier, who invented restorative wound fillers and wrote restorative art also became more common. In 1937, for example, The articles for The Casket and Sunnyside. Collier’s topics addressed facial Embalmers Graduate College in Chicago offered a 30-hour course of cancers, loss of limbs, common procedures and cosmetic techniques. restorative techniques and cosmetic application. Along with legitimate A.O. Spriggs (who worked for the Champion Co.), contributed a series programs such as the Chicago college came less authentic educational entitled “The Art of Plastic Surgery” that discussed such topics as hidden opportunities. In 1926, Dhonau, a noted expert in the field of restorative suturing methods, restorative techniques for gunshot wounds, and the arts, called it a scandal that fluid manufacturers were issuing diplomas correct injection of fluids. All the articles were eventually compiled into a for demisurgery to individuals who simply attended their free clinics, in textbook, published in 1934, called “Champion Restorative Art.” the same way that decades earlier, fluid manufacturers were criticized Clarence G. Strub published over a thousand articles and two texts, for issuing diplomas to those who had viewed their embalming “The Principles of Restorative Art,” a 32-page practical textbook, and seminars. Dhonau and others in the field called for professionalism and “The Principles and Practice of Embalming.” Both are the model for high standards in restorative art education. modern books on the study because of their clarity and simplicity, and both became primary texts for colleges of mortuary science. Another

Page 91 Funeral.EliteCME.com There were still cases in these days of bodies embalmed in the family By the mid-century, the two major trade journals, The Casket and home without the use of gloves or other protective measures. In some Sunnyside, both published a monthly article that ran for 14 years. cases, family members attended. The potential risk associated with Called “Restoration Clinic,” it described treatments for specific casual treatment of a dead body became a critical issue for Edward difficulties, with before and after photos to show results. C. Johnson, a funeral service professional who became infected during Gladys P. Curry, author of the 1947 “Textbook of Facial an embalming and nearly had to have a finger amputated. He recovered, Reconstruction,” became internationally known for her ability to identify and eventually became very well known in the field of restorative art, dead bodies after infamous disasters, such as a fire in a night club that writing scholarly articles on the history of embalming and funerals in killed more than 500 people, or the bodies of decomposing crewmembers the United States, and founding the Postgraduate Institute of Restorative of a submarine lost in 1939. Her book provides useful illustrations Art in 1948 in Chicago. Professor Johnson, his wife, Gail, and daughter and photographs that break down reconstruction into a series of steps, Melissa – all of whom were licensed funeral directors and embalmers – rebuilding each layer of the face from the bare skull to the muscles, to coauthored his publications and traveled the world with him presenting the soft tissues of the face and neck, eventually refining the skin surface embalming and restorative art lectures and demonstrations. The family and adding hair to achieve the most natural look. The Curry system was also critical in transporting the American victims of the Jonestown, was used for years by embalmers to assist law enforcement agencies in Guyana, suicides that shook the world in 1978. identifying skeletal remains. While the book is dedicated specifically to New products introduced in the 1930s helped to revolutionize reconstruction of the soft tissues of the head and neck with clay or wax restorative techniques. There had always been a problem with and does not discuss restorative difficulties or the use of embalming with application of cosmetics over a wax surface, an issue addressed in part reconstruction, it is an excellence reference on modeling techniques and by the invention of the airbrush or power sprayer as early as 1911. restorative techniques for purposes of identification. These devices were originally powered by carbon dioxide cylinders, Education in restorative methods was facilitated by the introduction then, in 1934, by a manually operated spray applicator sold with its of visual aids, such as photographs and film, which could show the own specific cosmetic set. A few years later, an industrial and artistic sequence and results of each technique or step. The earliest known airbrush equipment manufacturer created an airbrush kit designed film example isJoel Crandall in 1912, but other filmmakers followed, especially for embalmers. The Paasche Co. kit contained an electric such as Worsham and Renouard, using black and white film, before the air compressor, an airbrush applicator for restorative art wax, a set of 1920s, and K. Angstadt, filming in color, in the 1930s. Angstadt was a cosmetic tools, and a number of preformed facial features. Also at the skilled restorative artist from Pennsylvania who demonstrated techniques time, the Dodge Chemical Co. introduced a needle injector and needles in silent film with subtitles. His excellent technique and skill were evident that were fashioned for securing the mouth, also offering instruments, in a number of complicated restorations, including replacing a jaw that had cosmetics, wax and chemicals used for restorative art. been removed, reducing swelling of the face and hands, and replacement In 1943, Sheridan Mayer published “Restorative Art,” a basic text in of eyelids and lashes that had been ravaged by infection. In the 1940s, many educational institutions that was revised a number of times. He also two educational color films were produced. One, from the Los Angeles wrote the “Workbook on Color and Mortuary Cosmetology,” published College of Mortuary Science, shows how to create plaster masks that a few years later, and the textbook “Color and Cosmetics” in 1973. His can be used for practicing restoration techniques and describes modeling background was unusual in the field; trained as an artist and sculptor, he methods that are very effective in producing natural facial features. was also employed as a theatrical cosmetician and makeup expert. Perhaps It might be said restorative art formally “arrived” as a discipline in his greatest contribution to restorative art was his encouragement of a 1945, when it was the subject of the address at the National Funeral uniform curriculum and standards for instructional and testing purposes. Directors Association Convention in Chicago, with content stressing While not an embalmer, he prepared sample syllabi and curricula as well the value and necessity of these procedures. as examination questions that became standards in the field of study.

Infamous cases of early modern restorative art

John Dillinger, Bonnie Parker and Clyde Barrow (“Bonnie and Clyde”) Louisiana, after which Clyde’s body went to Dallas, where his head, were killed by law enforcement agents in the summer of 1934. Dillinger, which was shattered by over 100 bullets, was restored, while Bonnie, taken to the Cook County Morgue in Chicago, was met there by an who had received more than 50 bullet wounds, was taken to a different instructor from Worsham’s College, who was requested to make a death funeral home in Dallas. Extensive restorative work was completed on mask of Dillinger for the FBI. Bonnie and Clyde were embalmed in both, and both were viewed by an estimated 50,000 individuals.

PART II: IS EMBALMING DANGEROUS? This section discusses risks associated with embalming, highlighting formaldehyde regulations. These findings are followed by a review of recent findings associating long-term exposure to formaldehyde to a proper ventilation for funeral home preparation rooms, and an article higher risk of myeloid leukemia among embalmers. These findings, as discussing health risks associated with older cemeteries or contact with well as recent OSHA investigations showing violations in workplaces corpses embalmed from around the time of the Civil War until the early that use formaldehyde, emphasize the potential risk – to one’s safety 1900s, when arsenic was commonly included in embalming fluids. and one’s business – that can occur without proper attention to

National Cancer Institute findings

The November 2009 Journal of the National Cancer Institute published malignancies and brain tumors with those who died from other causes. some disturbing new findings about exposure to formaldehyde. In this Lifetime work practices and exposures to formaldehyde were obtained by recent study, researchers at the National Cancer Institute investigated the interviews with next of kin and coworkers. relation of mortality to work practices and formaldehyde exposure levels This study was the first epidemiological investigation, to the authors’ among a number of professionals, including embalmers. In a case-control knowledge, to relate cancer risk to duration of employment, work practices study among funeral industry workers who had died between 1960 and and estimated formaldehyde exposure levels in the funeral industry. 1986, researchers compared those who died from lymphohematopoietic

Funeral.EliteCME.com Page 92 The study found that death from myeloid leukemia increased with 3,068 embalming procedures. There was also a threefold risk for those increasing years of embalming experience. There was an almost fourfold estimated to have exposures exceeding 9,253 parts per million-hours. increased risk of death from myeloid leukemia among persons who However, they did not find a statistically increased risk for mortality performed embalming for more than 34 years. There was a threefold from brain tumors or other lymphohematopoietic malignancies. risk of death from myeloid leukemia in persons performing more than

So what is the current status of formaldehyde use in the embalming profession?

Funeral professionals and organizations responsible for protecting ●● http://www.nfda.org/additional-tools-embalming/1901- their welfare continue to monitor the international, federal and state formaldehyde-understanding-the-newest-study-on-cancer-and- regulatory landscape for changes or limits on the use of formaldehyde exposure-in-funeral-service.html for embalming purposes in the United States. ●● http://nfda.org/additional-tools-embalming/1749-formaldehyde- The National Funeral Directors Association (NFDA) has performed best-management-practices.html a preliminary analysis of the report that will likely be updated after The NFDA is also completing a ventilation study to evaluate prep room further review. The NFDA has published two articles regarding the ventilation systems to ensure they are providing the maximum protection recent formaldehyde study results, which can be found on its website at for embalmers from formaldehyde exposure during embalming. these links. The first reviews the most recent research findings regarding cancer and formaldehyde, and the second outlines best management Given that the International Agency for Research on Cancer (IARC) practices for workplaces using formaldehyde, including appropriate has declared formaldehyde a carcinogen and the federal Environmental ventilation standards (which are also presented in the next section): Protection Agency (EPA) is reviewing the recent data regarding formaldehyde exposure and leukemia, it is expected that both the EPA and OSHA will propose new regulations limiting the use and exposure limits for formaldehyde based on all these studies.

Workplace violations

Given the widespread knowledge that formaldehyde exposure can OSHA found that the plant lacked a process safety management be dangerous, there is surprising laxity regarding storage and use of (PSM) program and procedures to proactively assess and address the product. In October 2009, the OSHA cited a large Massachusetts hazards associated with processes and equipment using large amounts company for 41 alleged violations of workplace safety and health of formaldehyde and that the plant also lacked controls and other standards at its Cambridge production plant. The embalming fluid safeguards to reduce the levels of formaldehyde to which some manufacturer faces $138,000 in fines for inadequate safeguards workers were overexposed. involving formaldehyde stored and used in manufacturing processes OSHA also identified numerous deficiencies in the plant’s respiratory at the plant as well as for various chemical, mechanical and electrical protection, emergency response, hazardous energy control, chemical hazards identified during comprehensive OSHA inspections conducted hygiene and chemical hazard communication programs. over the past several months.

Ventilation requirements

Although ventilation requirements for preparation rooms may be changing in the near future, be sure your workplace meets minimum safety standards according to the following guidelines.

Ventilation guidelines and calculations for funeral home preparation rooms1

Ventilation guidelines

Ventilation requirements for funeral home preparation rooms are not ●● The National Funeral Directors Association recommends, as an specifically addressed in current OSHA guidelines. However, the National accepted industry practice, no fewer than 10-15 air changes per Mechanical Code of the Building Officials and Code Administrators hour for preparation rooms. (BOCA) and the Heating, Ventilation, and Air-Conditioning Handbook ●● A source of makeup air should also be provided in preparation of the American Society of Heating, Refrigerating, and Air-Conditioning rooms to prevent excessive negative pressurization and to improve Engineers (ASHRAE) specify ventilation criteria for autopsy rooms. air mixing within the room. These criteria for autopsy rooms can serve as useful guidelines for effectively ventilating funeral home preparation rooms. ●● BOCA requires a minimum of 12 air changes per hour for autopsy rooms. The BOCA Code also requires that the air shall be exhausted to the outdoors, at an approved location on the exterior of the building. ●● ASHRAE recommends a minimum of 12 air changes per hour be supplied to autopsy rooms, and that at least two of the air changes per hour be outdoor air. ASHRAE also specifies that the room be negatively pressurized in relation to adjacent areas.

Page 93 Funeral.EliteCME.com Ventilation calculations Air changes per hour (ACH) – To determine the number of air 5. Calculate air changes per hour (ACH): changes per hour occurring in an existing preparation room: ○○ CFH (ft3/hr) I room volume (ft3) = ACH (air changes per hour). 1. Calculate volume of preparation room: ○○ Sample calculation for air changes per hour (ACH). ○○ Length (ft) x width (ft) x height (ft) = room volume (ft3). ■■ Preparation room is 30 ft. long x 20 ft. wide x 10 ft. high 2. Calculate exhaust vent area in ft2: with an 18-inch-diameter circular exhaust fan vent having ○○ If rectangular: length (in) x width (in) = vent area (in2). an average face velocity of 860 FPM. ○○ If circular: 3.141 x [radius (in)]2 = vent area (in2). ■■ Room volume = 30 ft x 20 ft x 10 ft = 6,000 ft3. ○○ Vent area (in2) x 0.00694* = vent area (ft2). ■■ Vent area = 3.141 x (9 in)2 = 254.4 in2 x 0.00694 = 1.77 ft2. ■■ (* = factor for converting in2 to ft2). ■■ CFM = 860 FPM x 1.77 ft2 = 1,522 CFM (ft3/min). 3. Calculate volumetric airflow of exhausted air in cubic feet per ■■ CFH = 1,522 CFM x 60 min/hr = 91,320 CFH (ft3/hr). minute (CFM): ■■ ACH = 91,320 CFH I 6,000 ft3 = 15.2 ACH. [NOTE: This will require airflow measurements using a velometer Ventilation system capacity – To determine the ventilation system or equivalent instrument to determine average air velocity in feet capacity in cubic feet per minute necessary to obtain a desired number per minute (ft/min) across the face area of the preparation room of air changes per hour. exhaust vent. More sophisticated measurement methods, such as 1. Calculate volume of preparation room: duct static pressure, may also be used. Alternatively, a volumetric ○○ Length (ft) x width (ft) x height (ft) = room volume (ft3). airflow hood can be used to directly obtain CFM.] 2. Calculate cubic feet per hour (CFH) needed: ○○ Air velocity (ft/min) x vent area (ft2 3 ) = CFM (ft /min). ○○ VOLUME (ft3) x ACH (desired) = CFH (needed). 4. Convert CFM to cubic feet per hour (CFH): 3 3 3. Convert to cubic feet per minute (CFM) needed: ○○ CFM (ft /min) x 60 (min/hr) = CFH (ft /hr). ○○ CFH I 60 (min/hr) = CFM (needed).

Sample calculation for ventilation system capacity

Preparation room is 26 ft. long x 18 ft. wide x 9 ft. high and it is Calculation of the outside supplied air changes recommended by necessary to determine the number of cubic feet per minute that must ASHRAE can be performed in the same manner as those for exhausted air. be exhausted to obtain 15 air changes per hour. ●● 4,212 ft2 x 15 ACH = 63,180 CFH (ft3/hr). ●● 63,180 CFH I 60 min/hr = 1,053 CFM (ft3/min).

Hidden dangers

The following article cautions those working near old burial sites or contact with the embalmed bodies and possible contamination of treating embalmed bodies from certain periods, particularly the Civil ground water and soil. Please pass the information along to anyone War, to protect themselves from risk of exposure to arsenic through you feel might benefit from it.

Old cemeteries, arsenic, and health safety2

Embalming human remains for burial has taken a long road to its the primary embalming agent because it effectively killed or halted present state as an art that now minimizes health and environmental the microorganisms responsible for decomposition. Other embalming concerns of burials. Along the way, health and safety were not always compositions were used less frequently and contained similar toxic considerations. From the Civil War until about 1910, arsenic was materials, such as mercury or creosote. the main ingredient in the embalming fluids used widely throughout At the end of the Civil War, successful embalmers returned to their the country. Although effective, arsenic is toxic and persistent, and hometowns and took their craft with them. This expansion of arsenic- elemental arsenic will never degrade into harmless byproducts. based embalming gradually came to encompass all areas of the country. Progress in embalming practices during the late 1880s has left a legacy From 1856 to 1873, six patents were issued for fluids that contained that can potentially harm the health of archeologists or cemetery arsenic, from as little as four ounces to as much as 12 pounds of workers, and impact the environment. Awareness of this potential arsenic per body. Individual embalmers could also create their own problem is the first step in alleviating any real damage that might occur. formulas by going to the local pharmacy to get the necessary quantities Arsenic embalming began as a sanitary practice and a practical means of arsenic. The 1878 publication, “The Undertaker’s Manual,” to preserve the body until burial or for transport. Considering that contained several embalming fluid formulas, the majority of which the alternative was ice, arsenic embalming seemed like a significant were arsenic based. A popular formula of the time contained about four improvement. What the embalming practitioners or undertakers did not ounces of arsenious acid (an arsenic trioxide) per gallon of water, with consider were the long-term effects of placing significant amounts of two or more gallons of fluid recommended for proper embalming. arsenic in concentrated burial areas – cemeteries. Chemical embalming spread most rapidly in the 1880s, when fluids were The arsenic that endures today can pose significant danger to forensic compounded and sold commercially. Fluid compounders sent salesmen archeologists, cemetery workers, or individuals that may be utilizing on the road to demonstrate fluid use and broaden their customer base. potentially contaminated groundwater supplies. The salesmen provided at least rudimentary instruction in embalming In the U.S., the widespread use of arsenic in embalming fluids began techniques and helped continue the growth of chemical embalming. in the Civil War period. Dr. Thomas Holmes, the “father of American The demand for chemical embalming stimulated the creation of embalming,” was engaged by the medical department of the Union embalming institutes or schools. Some of the earliest were the Army to set up battlefield embalming stations to enable the bodies of Rochester (New York) School of Embalming and the Cincinnati Union dead to be returned home. Numerous embalmers were trained School of Embalming. Correspondence courses overcame geographic in these new techniques, which included preparation of embalming barriers and embalming practitioners began providing services in fluids. Although fluid composition was often a trade secret, arsenic was every state. For example, chemical embalming in Iowa began about

Funeral.EliteCME.com Page 94 1879. An enterprising young undertaker from Iowa City, Dr. William soil or human remains at old burial sites or cemeteries? Because the main Hohenschuh, took a correspondence course from Dr. Auguste routes of exposure are ingestion, inhalation and skin contact, there can be Renouard, founder of the Rochester School of Embalming. Dr. important health and safety implications for personnel working at sites Hohenschuh spread the technique to his fellow undertakers, and by where arsenic is present in sufficient concentrations. 1899 there were at least 240 registered embalmers in Iowa. Acute arsenic poisoning by ingestion can occur as the result of hand Burial practices during this time also have a bearing on problems contact with dusts or objects containing arsenic compounds, and associated with the release of arsenic. Initially, burials were primarily subsequent hand-to-mouth contact. Another common mechanism in wood coffins that were placed directly in the ground. Throughout the includes the dust settling on objects that later have contact with the latter 1880s, use of metal burial containers, such as the Fisk metallic mouth, including the tops of soda cans, cigarettes in a shirt pocket or burial case and combination metal and wood caskets, increased. In either eating utensils. The smallest recorded fatal dose is 130 mg, although case, no burial vaults that enclosed the coffin were used. Embalming and recovery has occurred after much larger doses. metal containers added cost to funeral arrangements, and were generally Most ingested arsenic is quickly absorbed through the stomach and only used by those who could afford them. In many cases, burial of non- intestines and enters the blood stream. A common effect of arsenic embalmed persons in wooden caskets was still the only viable option. ingestion is irritation of the digestive tract, leading to pain, nausea, Yet embalming became increasingly affordable and popular. vomiting and diarrhea. Other effects characteristic of oral exposure Both wooden and metal caskets will eventually degrade and begin to include abnormal heart function and impaired nerve function, causing allow contact of the embalmed remains with the environment. Arsenic, a “pins and needles” sensation in the feet and hands. a basic element, will not change or degrade, but must remain with The inhalation route of exposure may be operative at dry, dusty sites, the remains or move into the environment. As the containers corrode, or during the handling of objects coated with dust. Inhalation exposure water moving downward through the soils of cemeteries can dissolve to arsenic can produce the same types of systemic health effects as arsenic from the burials and move arsenic into the soil or groundwater. oral exposure, although symptoms and effects are usually milder. The This slow spread of arsenic from numerous sources in an old cemetery current Occupational Safety and Health Administration Action Level can lead to serious environmental and health problems. for arsenic inhalation exposure is 0.005 mg/cubic meter. To understand the potential impact, assume a hypothetical cemetery Direct dermal contact with arsenic compounds may result in mild to in a modest-sized town. It is reasonable for the period 1880 to 1910 to severe irritation of the skin (dermatitis), as well as irritation to the assume that 2,000 people died in that time period. mucous membranes of the eyes, nose and throat. Dermatitis of the face If half of those were embalmed with arsenic, using six ounces of and eyelids is sometimes accompanied by conjunctivitis, with redness, fluid per person, the cemetery contains 380 pounds of arsenic. If the swelling and pain. embalmers in the area used more arsenic, such as three pounds per Due to the level of toxicity associated with arsenic, it is important to take person, then the cemetery would contain over one ton of arsenic. In precautionary measures when working in and around burial sites that either case, this is a significant amount of a potent, toxic material to may contain arsenic-embalmed remains. Protective measures include find in the ground at one location. using protective work clothing and equipment, housekeeping and hygiene In the early 1900s, arsenic use was banned from embalming. The practices. Individual project requirements may differ; Occupational driving force for the ban was the concern for health of embalming Safety and Health Administration standards, in particular 29 CFR practitioners and interference with autopsies after embalming had 1910.1028, can give further guidance on proper procedures. Protective occurred. Today, arsenic is prevalent in or near old cemeteries. Some work clothing would include coveralls or similar full-body work clothing, of the most compelling evidence is the recent analysis of the remains gloves and shoes or shoe coverlets. Face shields or vented goggles should of an embalmed Civil War soldier. The tissue sample revealed that be worn when necessary to prevent eye irritation. Protective clothing and arsenic was present at a concentration of 28,000 parts per million, or equipment should be replaced at least weekly, and preferably on a daily 2.8 percent. This is firm documentation that arsenic embalmed remains basis. Disposable clothing is preferred because laundering clothing and can carry the arsenic residue for many years. gloves can result in additional exposure problems. Evidence of elevated levels in the environment near old cemeteries is Disposal of arsenic-contaminated materials must comply with federal, only now beginning to emerge. Limited sampling of old hand-pump state, and local hazardous waste regulations. Engineering controls, such as wells that still exist at many smaller cemeteries has been conducted in exhaust ventilation, will not be available to control dust exposure in many Iowa. These wells typically access the shallow groundwater aquifer, applications. In that case, respiratory protection should be used to control and if still functional, can provide an initial indication of arsenic dust exposures within acceptable limits. The minimum level of respiratory presence. One problem with these old wells is that they are often protection would be a half-mask air-purifying respirator equipped with located up gradient or peripheral to the burial area of interest and do high efficiency filters. Efforts must be taken to keep the inside of the not provide the ideal groundwater sample. respirator free of dust, and filters should be changed frequently, usually at Fourteen hand-pump wells at a variety of Iowa cemeteries were least daily. Surfaces should be kept as free from dust as practical. Use of sampled for arsenic. The U.S. Geological Survey staff in Iowa City compressed air, sweeping or brushing should be avoided, because these did not expect detectable levels of arsenic in shallow groundwater methods will increase ambient air dust levels. Vacuuming is an effective samples. Two of the samples contained arsenic at 30 parts per billion, method; however, special high-efficiency equipment should be used. above the new proposed drinking water standard for arsenic. Smoking, eating or drinking should not be allowed in any work areas Installing groundwater monitoring wells near cemeteries can provide where arsenic may be present. Hands and face should be washed prior a better indication of the impact of arsenic. In one study at Hamilton to eating, drinking or smoking. Protective clothing must be removed College in Clinton, N.Y., up-gradient and down-gradient wells were and handled carefully to avoid the generation of dust. A separate area installed outside of the college cemetery, which contains at least 68 for storage of street clothes should be available, and a shower should graves from before 1910. Samples from the wells indicate elevated be taken at the end of each work period. These general guidelines levels of arsenic down-gradient from the cemetery. Zinc, copper and are a starting point for protective measures needed to work at old lead also increased down-gradient. cemeteries or with materials from old cemeteries that may contain arsenic embalmed remains. It is recommended that a certified industrial What significance does the presence of arsenic have for archeologists, hygienist be consulted before beginning a project for specific measures. cemetery workers and others that may come into contact with contaminated

Page 95 Funeral.EliteCME.com Without an extensive review of public agency or private funeral The best opportunities to ascertain the presence and impact of arsenic establishment records, accurate determinations of the number and in old cemeteries can come through cooperative efforts of forensic and location of arsenic-embalmed bodies present in the nation’s graveyards other archeology experts with environmental scientists. Opportunities is impossible. Even if records were made available, they may not to collect and analyze soil and groundwater samples from excavations contain sufficient information to verify use of arsenic and the effort to should be utilized. Not only will this provide information on the obtain such information would be enormous. dangers to the environment, it will also provide critical information needed for proper protection of those engaged in archeological endeavors that could expose them to arsenic.

Endnotes and References

1. http://www.state.nj.us/health/surv/documents/fuhomevent.pdf. ŠŠ Mayer, Robert G, Embalming History, Theory, and Practice, McGraw Hill, 4th Edition 2. John L. Konefes and Michael K. McGee; Additional assistance by Melissa Johnson 2006. Williams; http://crm.cr.nps.gov/archive/19-10/19-10-6.pdf ŠŠ Patty’s Industrial Hygiene and Toxicology, volume 2A. New York: John Wiley and ŠŠ Crane, O.N., M.P. Hatfield, A.B. Perrigo and H. Samson. The National Funeral Sons. 1981. Director’s Official Text Book.Chicago: Donohue & Henneberry, 1886. ŠŠ Renouard, A. The Undertaker’s Manual: A treatise of Useful and Reliable ŠŠ Gannal, J.N. History of Embalming and of Preparations in Anatomy, Pathology, and Information; Embracing Complete and Detailed Instructions for the Preservation of Natural History. Philadelphia: Judah Dobson, 1838. Bodies. Rochester, N.Y.: A.H. Nirdlinger & Co., 1878. ŠŠ Halsted, M. A Legacy of Excellence (History of Des Moines Funeral Directing). Des ŠŠ Strub, C.G., and L.G. Frederick. The Principles and Practice of Embalming. Dallas: Moines: Hamilton’s Funeral Home, 1984. L.G. Frederick, 1965. ŠŠ Hebenstein, R.L. and W.M. Lamers. The History of American Funeral Directing. ŠŠ U.S. Patent Office. U.S. Patent #15,972, 1856; Patent #30,576, 1860; Patent Milwaukee: The National Funeral Directors Association/Bulfin Printers, 1955 #38,747, 1863; Patent #44,495,1864; Patent #81,755, 1868; Patent #144,602, 1873. ŠŠ Johnson, E.C. A History of the Art and Science of Embalming. Casket and Sunnyside. Washington, DC. 1955. ŠŠ Wilson, L.E. History of 75 years of Funeral Service. Des Moines, Iowa: Iowa Funeral ŠŠ Johnson, E.C., G.R. Johnson and M.J. Williams. Dr. Homes Method of Preserving and Embalmers Association, 1963. Remains. The American Funeral Director. February, 1989.

History of Embalming and Restorative Arts

Final Examination Questions Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 112, or for faster service complete your test online at Funeral.EliteCME.com.

1. Our earliest knowledge of embalming is that which 6. Xaxos bodies show very minimal shrinkage in body size occurred in the Canary Islands among the Guanche. and are quite heavy. ¨¨ True  False ¨¨ True  False

2. The first step for the ancient Egyptian embalmer was the 7. By 1864, all deceased patients at the Washington, D.C., removal of the brain, typically with the use of a metal hook Military Hospital were routinely embalmed and the grave or spoon inserted through the nostrils into the brain, or less marked so that the body could be disinterred and sent to the commonly, through the eye socket. family, if desired. ¨¨ True  False ¨¨ True  False

3. Some of the success of Egyptian preservative methods 8. In the mid-1870s, the invention of the trocar by Samuel could likely also be attributed to a hot, dry climate that Rodgers helped to usher in a new system for treatment of discouraged bacterial growth. the cavities. ¨¨ True  False ¨¨ True  False

4. Populations of the Tigris-Euphrates River Valley, including 9. At the end of the 1890s, embalming fluid advertisements the Persians, Syrians and Babylonians, submerged recently were introducing the ingredient formalin, a saturated deceased individuals of importance in a container of plaster solution of formaldehyde combined with other ingredients. to preserve the body, especially for a long journey. ¨¨ True  False ¨¨ True  False 10. OSHA has issued ventilation guidelines for funeral 5. Guanche embalmers were gender-specific – only male preparation rooms for at least two decades. practitioners could attend to men’s corpses, and female ¨¨ True  False practitioners to women’s corpses. ¨¨ True  False

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